I would like to add further pertinent information to Dr. Kleinschmidt’s response regarding triglycerides (Item 125-2). One study examined 35 years of data from the Framingham Heart Study to establish the relationship between triglyceride levels and risk for coronary artery disease (CAD) (Can J Cardiol. 1988;4 Suppl A:5A-10A). Investigators found that triglyceride levels were an independent risk factor for heart disease, with the risk being higher for women than for men (J Am Acad Nurse Pract. 2008;20 Suppl 2:1-14). High triglycerides are also a primary risk factor in the metabolic syndrome. An elevated triglyceride level is a clinical concern that warrants further evaluation to include cardiovascular risk, metabolic syndrome, prediabetes, diabetes, and pancreatic function.—TERRY MCMANUS, FNP, Spokane, Wash.

Hypertriglyceridemia is a contentious topic. An extensive literature search reveals research that supports hypertriglyceridemia as an independent risk factor for CAD and a predictor for cardiovascular events. In a large meta-analysis of five studies involving 46,000 men and more than 10,000 women, the relative risk of CAD is approximately 1.14 for men and 1.37 for women ( J Cardiovasc Risk. 1996;3:213-219. Elevated triglyceride levels are rarely isolated and most commonly associated with other lipid disorders.

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The treatment of isolated hypertriglyceridemia as an independent factor for heart disease remains unsettled. There is no clear evidence that treating isolated hypertriglyceridemia reduces morbidity or mortality.

Evidence showing that elevated triglycerides are not a cause of metabolic syndrome but rather a consequence of metabolic syndrome is overwhelming, as evidenced by the association between insulin resistance and elevated triglycerides. For more information, see Arch Fam Med. 2000;9:189-190.—Debra Kleinschmidt, PhD, PA (137-15)